Inspection on 18/06/05 for Bromley Park Nursing Home

This inspection was carried out on 18th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bromley Park Nursing Home 02/07/07

Bromley Park Nursing Home 13/07/06

Bromley Park Nursing Home 06/02/06

Bromley Park Nursing Home 19/08/05

Bromley Park Nursing Home 25/02/05

Bromley Park Nursing Home 20/09/04

Bromley Park Nursing Home 17/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bromley Park Nursing Home 75 Bromley Road Beckenham Kent BR3 5PA Lead Inspector Rosemary Blenkinsopp Unannounced 18 June 2005 08.00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bromley Park Nursing Home Address 75 Bromley Road, Beckenham, Kent BR3 5PA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8650 5504 020 8650 6085 Nellsar Limited Jacqueline Hayward-Gant Care Home with Nursing 50 Category(ies) of Dementia (50) registration, with number of places Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice issued 29 April 1997. Date of last inspection 25/02/05 Brief Description of the Service: Bromley Park Nursing Home has been registered to its current owners since 1993. It is a large, detached house in a residential area of Beckenham, and provides nursing care to a maximum of 50 residents of either sex who are suffering with dementia. The building has been adapted for its purpose as a nursing home, and has had an extension added. Bedrooms are sited throughout the building and there is a lift giving access to all floors. The building is somewhat complex in its layout and some of bedrooms are an unusual shape. Communal areas are on the ground floor. There is a large back garden and car parking to the front of the building. There is a bus stop outside the home. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced at 08.00 am, by two inspectors. The inspection took place over three hours. The RGN in charge of the home facilitated the inspection. The inspectors viewed records including care plans and medication charts. The main focus of the inspection was on care practices, including privacy and dignity of residents. A partial tour of the premises was undertaken. Areas of the home were malodorous; some were hot and lacked sufficient ventilation. Residents and staff were spoken to during the inspection. Residents appear to have little choice in their day with the emphasis placed on routines and staff are task orientated. On this occasion the inspectors were of the view that health and safety practices, in addition to some maintenance issues, were not adequately addressing the safety for residents and staff working in the home, e.g. some fire exits were locked. This matter was immediately referred to the fire authorities for advice by the inspector. What the service does well: What has improved since the last inspection? What they could do better: Arising out of this inspection were a number of urgent requirements and further requirements which are documented at the end of this report. For example no fluids had been offered to residents, the temperature in the home was very hot and call bell leads missing. The privacy, dignity and respect issues of residents were poorly addressed. Supporting documentation including care plans and risk assessments were poorly completed and not reflective of needs. Medication procedures and record keeping also require further input. The administration of medication was not sufficiently robust to ensure safety of residents. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 6 These issues were raised with the manager and operations manager and they stated that they will deal with these issues immediately. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: No standards were assessed in this section. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Care plan documentation did not fully reflect the residents’ needs. Information was not reviewed in accordance with the changing needs of the residents nor included in risk assessment or other supporting documents. EVIDENCE: The care plans for three residents were identified during the tour of inspection, e.g. one gentleman who had an injury to his forehead, another resident in bed with pressure sores and dressings and another younger looking resident who was wandering in the communal areas. The resident with an injury to his forehead had three photographs indicating injuries. These were dated 9/6/05. He had a care plan for falls and reference to his risk of falling although fully mobile. His weight chart indicated that he had lost over ten kilos since 6/6/04. He was 69.8 kilos on that date and on the last weight record dated April 2005 he was 58 kilos. The RGN said that the resident had gained weight although the record could not be located. He had been seen by the Dietician 6/4/05 and recommendations made. His nutrition assessment remained at the same score of 3 – moderate risk; this had remained unchanged in the year, even though other factors such as sacral redness etc were present. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 10 In another care plan the nutrition assessment was stated as “0” although from the daily events there were concerns relating to her poor nutrition. Other information, which was incomplete, was weight charts including the admission weight. Wound care was recorded although there was little reference as to the progress. In another care plan the records relating to incontinence and the use of pads was conflicting as there had been no reference or history of incontinence previously recorded. The inspector observed one RGN administering the medication. The RGN used a tablespoon to administer the medication to residents; medication pots or a teaspoon were not used although available. Within the medication charts information was not fully completed including the record of allergies and medications received. Temezepam for one resident was stated to be administered “as directed“ without comprehensive administration instructions from GP. Medication must have full instructions. One medication was dropped by the RGN administering the medication, although she did not realise this and proceeded to sign for the medication. The inspector pointed this out. This resulted in an urgent requirement. Residents who were up in the lounge as the inspectors arrived at 8am, as the inspectors left 11am, some were still in their night attire in the lounge. During the inspection, residents’ privacy and dignity was not addressed. Some ladies were in very flimsy nighties with incontinence wear underneath and they were not covered sufficiently. Please see requirements 1, 2 and 3. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Residents have little choice in their day with the emphasis placed on routines and staff are task-orientated. EVIDENCE: As the inspectors arrived, 28 residents were up in the lounge some dressed some in night attire. Almost all residents were asleep and remained so until the inspectors left. One resident who was in bed, had been incontinent. The smell was evident in the bedroom and the adjacent corridor. On inspection she had an incontinence pad, net knickers, then another pad and a Kylie sheet. Faeces were on the duvet and her pillow was wet. The nurse on duty said that she spent the majority of her time in bed because she had pressure sores and was brought downstairs for short periods. Cot sides were in place. The room was bare except for a commercial calendar. The bed was positioned away from the window and faced a bare wall. There were no pictures ornaments TV, radio or anything else in the bedroom. There were no fluids and the call bell was behind the bed. This would be a very isolating experience for the resident who was described in her care plan as enjoying company. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 12 The windows to the front of the house overlook a main road. There are no net curtains for privacy. The curtains provided are lightweight without “black out” linings. No fluids were offered to the residents during the period of the inspection. The inspector was informed that residents, who are up, have breakfast about 6.45 a.m. in the dining room. This is very early and although residents may wake this may not indicate that they want to get up and eat breakfast. Individual choice should be paramount and if it is the case that early risers want breakfast, a record should be in place to indicate this preference. Other residents who were having breakfast later, sat at tables which were not laid with cutlery, crockery, condiments or tablecloths. It was a very hot day. One gentleman wanted to go in the garden. The doors to the garden are fire doors, these were locked. The staff member said that it was too busy in a morning to let people sit in the garden and the last time that they had been in the garden someone had escaped. This raises serious questions about the staffing levels in respect of individual activities and observation. Throughout the inspection in one part of the communal area the TV was playing children’s cartoons whilst the radio had pop music playing. No other entertainment was provided. It was stated that one man watched the cartoons. Please see requirement 4 and 5. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: No standards in this section were inspected. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25. Limited improvements in the décor have been made. The large communal areas with seating around the room give an institutional feel. EVIDENCE: The building is confusing in its layout and some of the bedrooms are unusual shapes. Many areas in the home were malodorous. Several areas including bedrooms were hot especially on the top floor and windows were closed. Generally call bell leads were not in place and there were no fluids in bedrooms. Jugs of fluids were located on the corridors although those seen were full at 8 am. Several clocks were wrong. Many cot sides were in use with additional padding over the cot sides. Soap, except for liquid soap, was not available in individual bedrooms. Towels and flannels were also absent including bedrooms, which were still occupied. The bedroom doors needed adjustment, as when they closed they slammed loudly. This would be a particular problem at night. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 15 The domestic was hoovering with a noisy machine at 08.05 am on the ground floor. It was pointed out that a resident was still in bed. At 08.10 am the domestic worker was hoovering on the first floor, five residents were still in bed. This was pointed out to the domestic staff. He said that normally the residents were all up and it was his usual routine. The dining room doors were dirty and sticky. Two pressure relieving cushions in the lounge were not working, one was disconnected the other was showing low pressure. Efforts had been made to facilitate orientation and signs were available in areas such as bathrooms and toilets. Please see requirements 6,7and 8. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staffing levels were not sufficient to provide residents with adequate supervision, individual care or recreational activities. EVIDENCE: On the morning of the inspection three qualified staff were on duty with six care staff and one doing bed making. As far as the inspector could establish this was the usual number of morning staff. The staffing notice refers to three qualified and seven care staff. There is no indication that one of those staff should be specifically making beds. One cook was on duty. In the lounge the only staff present was a qualified staff member doing the medication. No other staff were in this area to provide supervision to residents or attend to their needs. Many were calling for assistance to which the inspectors had to attend, ascertain their needs and seek appropriate help. One resident wanted to go for a cigarette and was asked to wait. He waited approximately one hour until someone was free to deal with him. As the inspectors departed at 11 am some residents remained in the lounge still in night attire, very sleepy and no fluids provided. Please see requirement 4. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38. The health and safety practices, in addition to the maintenance issues, do not provide for adequate safety for residents or staff working in the home. EVIDENCE: The main door to the home was locked and no-one the inspectors asked was able to open it. The main front door had large boxes in front of it, potentially obstructing it and impeding access. The three fire exits in the ground floor lounge areas were locked. The only access was though the door beside the kitchen. This matter was referred to the Fire Authorities for advice. One gentleman was seen in a communal area without any staff present, he was smoking. On checking his care plan it stated that he smokes under staff supervision. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 18 Two staff were seen transferring a resident into an easy chair using an under arm lift which is an inappropriate method of handling. This is not an acceptable technique in manual handling. The call bell leads for the nurse call system were disconnected. The panels, which accommodate the call bell lead connections, were not in close proximity to the resident’s bed. Bedside lighting is provided by fluorescent strips, however, in many rooms the protective cover was not in place. The inspector touched the lighting and found it very hot. This is a potential risk to residents. Please see requirements 9 and 10. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 x 15 2 COMPLAINTS AND PROTECTION 2 1 2 1 2 1 1 1 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 1 Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 20 yes. Are there any outstanding requirements from the last inspection? Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 21 STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Timescale for action 30/9/05 2. 9 13 3. 12 12 4. 5. 6. 27 15 22 18 16 23 7. 25 23 8. 26 23 9. 38 23 10. 38 13 Bromley Park Nursing Home The Registered Person must ensure that care plans reflect residents needs, reviewed at appropiate intervals and have supporting risk assessments in place. The Registered Person must Immedensure that procedures for iately medication administration are safe,and record keeping fully completed. The Registered Person must 30/6/05 ensure that privacy, dignity and the respect of residents are maintained at all times. The Registered Person must 30/6/05 ensure that there are sufficient staff to supervise residents. The Registered Person must Immedensure residents have sufficient iately food and fluids. The Registered Person must 30/6/05 ensure residents have a means by which to summon staff assistance. The Registered Person must 30/6/05 ensure that the environment is maintained at an appropriate temperature and all equipment is in full working order The Registered Person must immedensure that the home is iately maintained clean tidy and odour free. The Registered Person must 30/6/05 ensure ease of access/exit on all fire escapes. The Registered Person must Version 1.30 Page 22 30/6/05 G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc that health and safety ensure issues are included in all practices. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 15 Good Practice Recommendations The Registered Person should maximise orientation aids including a clearer menu with improved layout, which is displayed. Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bromley Park Nursing Home G51-G01 s10129 Bromley Park N H UI v225114 180605 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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